Standardized oral health assessment and scoring using digital imaging

ABSTRACT

System and methodology objectively capture clinical data on oral health and provide standardized scoring for quantifying oral health. The process of capturing clinical data is based on use of an intraoral camera with imaging software that has the capacity to capture digital images of all tooth surfaces. Digital plaque data are collected in a standardized manner per tooth, and with the ability to select optimal frames for analysis. Data are extracted per tooth into a software program. Color classification of each pixel is determined by the software program using an algorithm that makes use of red/green/blue color code combinations. These classifications are then quantitatively used within the software program and separate algorithms that automatically generate a range of oral health scoring techniques.

CROSS-REFERENCE TO RELATED APPLICATIONS

This nonprovisional application is a continuation-in-part of U.S.Nonprovisional patent application Ser. No. 15/366,741, entitled“Standardized Oral Health Assessment and Scoring Using Digital Imaging”,filed Dec. 1, 2016, which claims priority to U.S. Provisional PatentApplication No. 62/261,631, entitled “Standardized Oral HealthAssessment and Scoring Using Digital Imaging”, filed Dec. 1, 2015, allof which are incorporated herein by reference in their entireties.

FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

This invention was made with government support under Grant Number RO1NR007652 awarded by the National Institutes of Health. The governmenthas certain rights in the invention.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates, generally, to oral health assessments. Morespecifically, it relates to use of digital imaging to standardize,assess, and score oral health in a subject.

2. Brief Description of the Prior Art

Despite its prominent position in bedside care, there is little evidenceto judge the benefits or associated risks of nurse-administered toothbrushing for mechanically ventilated adults, and the optimal frequencyof tooth brushing in the critically ill has never been experimentallydetermined. Traditional methods for scoring oral health, including bothtooth (e.g., plaque burden) and gum (e.g., inflammation) health, haverelied upon visual examination by skilled professionals, includingdental hygienists. Given the relatively subjective nature of thisprocess, measurement of oral health is suboptimal for a number ofreasons including, but not limited to: time burden, lack of reliabilitywithin and between assessors, lack of universal standardized scoringalgorithms, and computational complexity in attempting to score oralhealth on multiple dimensions, such as simultaneous assessment of ageand extent of plaque burden.

Attempts have been made at evaluating and quantifying plaque and oralhealth. Examples include U.S. Pat. No. 8,110,178; U.S. patentapplication Ser. No. 12/832,652; U.S. patent application Ser. No.11/662,346; Lupita Jocelin Reyes Silveyra, Investigations on AutomatedMethods for Dental Plaque Detection, A thesis submitted to TheUniversity of Birmingham for the degree of Doctor of Philosophy, Schoolof Dentistry College of Medical and Dental Sciences, The University ofBirmingham, September 2011; Pretty I A, et al., Quantification of dentalplaque in the research environment, Journal of dentistry (2005), 33,(3), 193-207, ISSN:0300-5712; Michael G McGrady, et al., Evaluating theuse of fluorescent imaging for the quantification of dental fluorosis,BMC Oral Health (2012), 12, 47; and Rosa G M, et al., New portablesystem for dental plaque measurement using a digital single-lens reflexcamera and image analysis: Study of reliability and validation. Journalof Indian Society of Periodontology. 2015; 19(3):279-284.doi:10.4103/0972-124X.152415. However, none provide a standardized andobjective system for assessing oral health.

Accordingly, what is needed for both for clinicians and researchers is areliable, user-friendly, and fully objective and standardizedmethodology and system for quantifying and scoring oral health. However,in view of the art considered as a whole at the time the presentinvention was made, it was not obvious to those of ordinary skill in thefield of this invention how the shortcomings of the prior art could beovercome.

While certain aspects of conventional technologies have been discussedto facilitate disclosure of the invention, Applicants in no way disclaimthese technical aspects, and it is contemplated that the claimedinvention may encompass one or more of the conventional technicalaspects discussed herein.

The present invention may address one or more of the problems anddeficiencies of the prior art discussed above. However, it iscontemplated that the invention may prove useful in addressing otherproblems and deficiencies in a number of technical areas. Therefore, theclaimed invention should not necessarily be construed as limited toaddressing any of the particular problems or deficiencies discussedherein.

In this specification, where a document, act or item of knowledge isreferred to or discussed, this reference or discussion is not anadmission that the document, act or item of knowledge or any combinationthereof was at the priority date, publicly available, known to thepublic, part of common general knowledge, or otherwise constitutes priorart under the applicable statutory provisions; or is known to berelevant to an attempt to solve any problem with which thisspecification is concerned.

BRIEF SUMMARY OF THE INVENTION

The long-standing but heretofore unfulfilled need for an improved methodof assessing oral health is now met by a new, useful, and nonobviousinvention.

In an embodiment, the current invention is a method of assessing oralhealth in a patient or subject. The method includes capturing orrecording the frames of substantially all buccal, occlusal, and lingualsurfaces in the subject's set of teeth, using a suitable intraoralcamera. The frames are imported into an image processing softwareprogram that is implemented on a computing device. The frames areprocessed on the software program to generate images of the teeth to beanalyzed. The color of at least a plurality of the frames/images areanalyzed and classified to determine presence of yellow color, whereinyellow color indicates presence of plaque. Results of the color analysisare scored to objectively and quantitatively assess the subject's oralhealth.

Optionally, a dental barrier can be positioned over a lens of theintraoral camera, and a camera tip of the intraoral camera is positionedover the dental barrier.

The frames captured by the intraoral camera may be either photographstaken by the camera or video recordings taken by the camera. When theframes are photographs, the subject's teeth can be divided into aplurality of sections, including an upper right section, a lower rightsection, an upper middle section, a lower middle section, an upper leftsection, and a lower left section. Further, when the frames arephotographs, processing the frames can be performed by cropping eachimage such that the image includes the targeted tooth, and theresolution of the image can be lowered to a percentage of about 50 orless.

In other embodiments when the frames are photographs, the color of theimage is analyzed and classified by classifying the color of each pixelof the image. Further, each pixel is classified using RGB color codecombinations, wherein a three-dimensional point (x, y, z) defines thecolor of each pixel. Still further, the step of analyzing andclassifying color is further performed by dividing each color dimensionof the RGB color code combinations into four (4) categories: (0, 64),(64, 128), (128, 192), and (192, 255). A middle point is selected ineach category to be representative of the corresponding category. Allcategories are then cored to determine when yellow color is present oneach pixel. When this is done, it was found that yellow color is presenton each pixel when a value of a red dimension is between about 0.75times of a value of a green dimension and about 2.5 times of the valueof the green dimension, and when the values of the green and reddimensions are at least about 1.2 times a value of a blue dimension.Optionally, scoring the results of the color analysis can includecalculating a percentage of yellow color in an image by dividing thenumber of yellow pixels by the total number of pixels in the image.

As noted previously, the frames may be video recordings. In this case,the subject's teeth can be divided into a plurality of quadrants,including an upper right quadrant, a lower right quadrant, an upper leftquadrant, and a lower left quadrant. Video should be captured andrecorded in at least one upper quadrant and at least one lower quadrant.Optionally, the following order can be used to take video in eachquadrant: capturing and recording video of the buccal surfaces in thequadrant, followed by capturing and recording video of the occlusalsurfaces in the quadrant, followed by capturing and recording video ofthe lingual surfaces in the quadrant, and followed by repeating theforegoing steps in another quadrant.

In other embodiments when video recordings are used, processing theframes includes extracting single still frame digital images of thetooth surfaces from the video recording. Optionally, each image iscropped, and a resolution of the image can be lowered to a percentage ofabout 50 or less. The color of the image is analyzed and classified byclassifying the color of each pixel of the image. Further, each pixel isclassified using RGB color code combinations, wherein athree-dimensional point (x, y, z) defines the color of each pixel. Stillfurther, the step of analyzing and classifying color is furtherperformed by dividing each color dimension of the RGB color codecombinations into four (4) categories: (0, 64), (64, 128), (128, 192),and (192, 255). A middle point is selected in each category to berepresentative of the corresponding category. All categories are thencored to determine when yellow color is present on each pixel. When thisis done, it was found that yellow color is present on each pixel when avalue of a red dimension is between about 0.75 times of a value of agreen dimension and about 2.5 times of the value of the green dimension,and when the values of the green and red dimensions are at least about1.2 times a value of a blue dimension. Optionally, scoring the resultsof the color analysis can include calculating a percentage of yellowcolor in an image by dividing the number of yellow pixels by the totalnumber of pixels in the image.

Optionally, when video recordings are taken, a plurality of frames fromall frames can be randomly selected prior to processing the frames onthe software program. This random selection can be performed with orwithout criteria for the random selection.

In a separate embodiment, the current invention is a method of assessingoral health in a patient or subject, comprising any one or more—or evenall—of the foregoing steps.

These and other important objects, advantages, and features of theinvention will become clear as this disclosure proceeds.

The invention accordingly comprises the features of construction,combination of elements, and arrangement of parts that will beexemplified in the disclosure set forth hereinafter and the scope of theinvention will be indicated in the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed incolor. Copies of this patent or patent application publication withcolor drawing(s) will be provided by the Office upon request and paymentof the necessary fee.

For a fuller understanding of the invention, reference should be made tothe following detailed description, taken in connection with theaccompanying drawings, in which:

FIG. 1 is a flowchart depicting the steps of oral health assessment,according to an embodiment of the current invention.

FIG. 2 is a flowchart depicting the steps of capturing data, accordingto an embodiment of the current invention.

FIG. 3 is a flowchart depicting the steps of scoring data, according toan embodiment of the current invention.

FIG. 4A is an image of a tooth using the “intra-oral” setting of theintraoral camera.

FIG. 4B is a schematic of “perio mode” of the ACTEON SOPROCARE intraoralcamera.

FIG. 5 depicts the R code for obtaining the final plaque percentage forthe tooth.

FIG. 6 is a chart depicting color samples that can be classified as‘yellow’ color (plaque) or non-yellow color (normal).

FIG. 7 depicts the R code for randomly selecting fifty (50)numbers/frames from a video recording.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

In the following detailed description of the preferred embodiments,reference is made to the accompanying drawings, which form a partthereof, and within which are shown by way of illustration specificembodiments by which the invention may be practiced. It is to beunderstood that other embodiments may be utilized and structural changesmay be made without departing from the scope of the invention.

As used in this specification and the appended claims, the singularforms “a”, “an”, and “the” include plural referents unless the contentclearly dictates otherwise. As used in this specification and theappended claims, the term “or” is generally employed in its senseincluding “and/or” unless the context clearly dictates otherwise.

In an embodiment, the current invention uses digital imaging technologyto objectively capture clinical data on oral health, and then providesstandardized scoring methodology for quantifying oral health. Themethodology is applicable to persons in clinical settings (includinghospitalized patients) as well as the general population. Generally, itinvolves two (2) stages (see FIG. 1): the process of capturing clinicaldata by use of digital imaging technology, and the process ofstandardized scoring of oral health data.

Capturing Clinical Data (FIG. 2)

The process of capturing clinical data on oral health is based on theuse of a conventional intraoral camera (e.g., ACTEON SOPROCAREDiagnostic/Clinical Intraoral Cameras) that has the capacity to capturedigital images of all tooth surfaces in white light within and outsideof dental laboratory settings. Any suitable intraoral camera iscontemplated herein. Data from the digital images are used to enhancethe detection of plaque on tooth surfaces, which are difficult todirectly observe and score by a dental hygienist. Imaging software(e.g., ACTEON SOPRO Imaging Software) is used in conjunction with thecamera to visualize, capture, and store each subject's digital imagerecording.

The process of digital imaging divides the subject's full set of teethinto four (4) quadrants. These quadrants include an upper rightquadrant, lower right quadrant, upper left quadrant, and lower leftquadrant. The recording of buccal, occlusal, and lingual surfaces ofeach quadrant in video-mode is significantly more effective andefficient than taking multiple still frame images at the bedside. Eachtooth's digital plaque data is collected in a standardized manner, andwith the ability to select optimal frames for analysis.

Scoring Clinical Data (FIG. 3)

When not utilizing intraoral cameras, dental plaque burden isconventionally scored by visual examination by use of the University ofMississippi Oral Hygiene Index (UM-OHI). Using visual examination, forthe ten (10) sections of each tooth, plaque is scored as present (valueof 1) versus absent (value of 0). Thus, the maximum plaque score pertooth is 10. The mean plaque score for the subject is calculated bydividing the total score by number of teeth. By way of contrast, withthe intraoral camera and imaging software, according to certainembodiments of the current invention, each tooth's data is extractedinto a software program, such as but not limited to R, and with aminimum of about 10,000-40,000 color-derived pixels per tooth.

The color classification of each pixel is determined by the softwareprogram using an algorithm that makes use of red/green/blue (RGB) colorcode combinations. These classifications are then calculatedquantitatively within the software program, and a separate algorithmautomatically generates a range of oral health scoring techniques. Theseinclude, but are not limited to: (i) magnitude (and ratio) of dentalplaque per tooth and across all teeth; (ii) estimated age of dentalplaque per tooth and across all teeth; and (iii) ratio of plaque burdento plaque age per tooth and across all teeth. The process of oral healthscoring is set up such that after appropriate selection of digitalimages has been achieved with use of the intraoral camera, and afterthese data have been imported into the computer coding language/program(e.g., R), only a few key strokes are required to compile and executethe algorithmic code, thereby resulting in standardized and nearreal-time scoring of oral health.

Example Capturing Data

A conventional intraoral camera, such as SOPROCARE by ACTEON usedherein, illuminates dental tissue with a wavelength of light between 440nm and 680 nm. Exposed tissue absorbs the energy and reflects it inflorescent form. The handheld intraoral camera can be connected to acomputing device wirelessly or by way of a video cable. If a wiredconnection is used, the video cable is connected to both the intraoralcamera and the computing device. The dental camera electrical supply isdirectly powered through the computer USB port. The voltage powering thecamera is of continuous 5 V low voltage type (0.5 A). On the computingdevice, imaging software, such as SOPRO

Imaging software, such as SOPRO V2.3 used herein, is required tovisualize, capture, and store video and digital images taken by theintraoral camera. Upon initiating the imaging software, a procedure filewas created for each subject in order to record and store the digitalimages. The computing device was placed near the subject's head duringthe procedure in order to use the monitor as the display screen tovisually guide the intraoral camera over each tooth surface. The camerafocus ring was set to intraoral mode for video capture and/or cameradigital image capture.

The mode on the intraoral camera was then set to the appropriatesetting. On the ACTEON SOPROCARE camera for example, there is a rotatingfocus ring used to focus from “0” to infinite. The “intra-oral” (1-5teeth) setting captures an image that is 5 mm to 30 mm from the camera.This setting was used for both video and camera digital image capture.See FIG. 4A. Additionally, the ACTEON SOPROCARE camera has a “periomode”, which is a fluorescent mode that is associated with chromaticamplification to highlight dental plaque using ultraviolet light. This“perio mode” revealed both old and new plaque in various stages. Newplaque was interpreted as a white color, while older plaque wasinterpreted as yellow or orange colors depending on its mineralization.See FIG. 4B. Perio mode was used herein to capture video and cameradigital images.

A disposable dental barrier can be placed over the camera lens, followedby the optional placement of a camera tip over the dental barrier. Thecamera tip enables displacement of ambient lighting. In the event of ananatomically small mouth or an oral cavity that is minimized due tofacial and tongue swelling, the intraoral camera can capture adequatedigital images of dental plaque without using a camera tip.

Mouth props may be used to assist subjects with or without anendotracheal tube to keep the mouth open wide enough for movement of theintraoral camera during the procedure. The mouth prop would be placed onthe opposite side of the mouth being recorded.

At this point, the intraoral camera can initiate video or camera digitalimage recordings. For video recordings, the subject's full set of teethwere visualized in four quadrants. These quadrants included an upperright quadrant, lower right quadrant, upper left quadrant, and lowerleft quadrant. The speed of video digital imaging decreases the amountof subject burden. Pausing 1 to 2 seconds over each tooth surface willenhance the quality of still frame images to be produced from the videoat a later time. In preparation for unforeseen events that make itimpossible to complete digital imaging of all four quadrants, it is morerepresentative data of oral health to obtain one-half of a full set ofdigital images from an upper quadrant and lower quadrant than one-halfof a full set of digital images that is either both upper quadrants orboth lower quadrants. Recording tooth surfaces closest to theendotracheal tube is recommended to be completed last, in case thesubject is susceptible to coughing or gagging with incidental movementof the endotracheal tube. Placing the intraoral camera close to themouth at the initiation of image recording and again at the conclusionof image recording can assist in protecting the subject's identity byavoiding incidental recording of a camera-facing headshot.

These video recordings can be obtained in any suitable way. Thefollowing is an exemplary step-by-step methodology for taking theserecordings. First, the technician or other member of the medical team(herein the “operator”) can lift the subject's upper lip with a freehand to expose the full buccal surface of the central and lateralincisor areas. The camera is held steady over the subject's firstavailable upper quadrant front tooth for 1-2 seconds and over eachbuccal tooth surface thereafter, moving the camera over the central andlateral incisor area. Alternatively, the camera does not need to stop orbe held steady for 1-2 seconds over each tooth surface; rather, thecamera can simply take a continuous video along the rows of teeth, andframes can be extracted from that video, as will become clearer as thisspecification continues.

The operator's free hand can be used to guide the camera distally overthe cuspid and molar areas, until the buccal surface of the subject'slast tooth in the back of the mouth and in the upper quadrant isrecorded. The camera lens is angled to capture the full biting surfaceof this same last back tooth, pausing 1-2 seconds over the bitingsurface of each tooth (or alternatively the camera does not need to bepaused over the tooth surface), and moving the camera over the molar andcuspid areas, thus guiding the camera towards the lateral and centralincisor areas until the biting surface of the subject's first fronttooth in the upper quadrant is recorded.

The camera lens is then angled to record the lingual surface of thissame first front tooth, pausing 1-2 seconds over the lingual surface ofeach tooth (or alternatively the camera does not need to be paused overthe tooth surface), and moving the camera over the central and lateralincisor area, thus guiding the camera distally over the cuspid and molarareas until the lingual surface of the subject's last back tooth in thisupper quadrant is recorded. On the same side of the mouth, the camera ismoved down to record the buccal surface of the subject's last back toothin the lower quadrant, pausing 1-2 seconds over the buccal surface ofeach tooth (or alternatively the camera does not need to be paused overthe tooth surface), and moving the camera over the molar and cuspidareas in the lower quadrant.

The operator can then use a free hand to move the lower lip down toexpose and record the full buccal surface of each tooth in the lateraland central incisor area, until the subject's first front tooth in thelower quadrant is recorded. The camera lens is angled to capture thefull biting surface of this same front tooth, pausing 1-2 seconds overthe biting surface of each tooth (or alternatively the camera does notneed to be paused over the tooth surface), and moving the camera overthe central and lateral incisor areas, thus guiding the camera distallyover the cuspid and molar areas until the biting surface of the lasttooth in the back of the subject's mouth in the lower quadrant isrecorded. The camera lens is then angled to begin recording the lingualsurface of this same last back tooth, pausing 1-2 seconds over thelingual surface of each tooth in the molar and cuspid areas (oralternatively the camera does not need to be paused over the toothsurface), and guiding the camera over the lateral and central incisorareas until the subject's first front tooth in this lower quadrant isrecorded.

If a mouth prop is being used, move it to the opposite side to continuerecording. The foregoing sequence of video recording is then repeated onthe opposite side of the subject's mouth. Once the recording of everytooth surface is complete, recording can be stopped. If needed, themouth prop can be removed and placed inside a sealable biohazard bag fortransport to the lab to be cleaned and sterilized.

Similar to video recordings, single frame images can be obtained in anysuitable way. The following is an exemplary step-by-step methodology fortaking these digital images. The subject's full set of teeth can bevisualized in six sections. These sections include an upper right, lowerright, upper middle, lower middle, upper left, and lower left. Theoperator's free hand can be used to lift the subject's upper lip toexpose the full buccal surface of the central and lateral incisors. Incamera mode, along with the intra-oral setting, a digital image of up to6 teeth is captured in each section on the buccal side and again on thelingual side for a total of 12 digital images that represent all toothsurfaces in that particular quadrant.

At the completion of video or camera recordings of all tooth surfaces,the subject's file is saved and closed, to be prepared and analyzed at alater time. In preparation for analysis, single still frame digitalimages of each tooth surface can be produced from the video recordingwith digital imaging software. Secure storage of these video files andsingle image files make it possible to maintain archival data that canbe better subjected to additional analysis and reliabilitydeterminations.

Analyzing Data

Generally, to calculate the percentage of plaque in a given image, theimage of the tooth is cropped, so that the image only includes thetargeted tooth in the image without losing the integrity of the tooth.Imaging software is then used to lower the resolution. The image isresized to a percentage of 50 or less (or to reset the pixel to 100 inhorizontal percentage, and the vertical percentage will be automaticallyadjusted). The R program is then run to obtain the plaque percentage forthe tooth (see FIG. 5 for the R code to obtain the final plaquepercentage for the tooth).

More specifically as it pertains to the step of the R program obtainingthe plaque percentage, to digitize the color, most software programs usethree dimensions to record the color, namely the RGB. The softwareprograms score the value of a specific pixel on each dimension, and athree-dimensional point (x, y, z) uniquely defines the color of thespecific pixel. The software uses two digits for each color dimension,and each digit uses a hexadecimal system to count the numbers.Therefore, there are 256 possible values to score each dimension of thecolor. Since an objective herein was to calculate the percentage ofplaque on a tooth and a typical plaque is always presented in a yellowcolor, the calculated score was used to judge whether each pixel shouldbe classified as yellow or not.

The determination of whether a pixel should be considered yellow can beachieved and implemented in any suitable manner. For example, asdescribed herein for illustrative purposes, the combinations of thethree colors (RGB) that can create ‘yellow’ were determinedquantitatively. Each color dimension was divided into four categories:(0, 64), (64, 128), (128, 192), (192, 255). Four categories were chosenbecause that was considered an acceptable compromise for accuracy andcomputational difficulty. Thus, in total, the end result was 64categories. Next, the middle point of each range was chosen—32, 96, 160,224—to be the representative of that range; the color for that specificcombination was used to represent the color for that category. Forexample, for the category (0, 64) in red, (0, 64) in blue and (0, 64) ingreen, the color of point (32 in red, 32 in blue, and 32 in green) wasused to represent the color for that category. After all 64 categorieswere scored, it was found that there were several common propertiesshared for those categories that are identified as yellow. These commonproperties are listed as follows:

-   -   1. The value of the red dimension was found to be between about        0.75 times of the value of the green dimension and about 2.5        times of the value of the green dimension.    -   2. The value of both the green dimension and the red dimension        were found to be at least about 1.2 times of the value of the        blue dimension.

Accordingly, if the values of the pixel met the conditions above, it wasclassified as yellow. If not, the pixel was not classified as yellow.After results were obtained for each pixel, the percentage of yellowcould be calculated by using the number of yellow pixels divided by thetotal number of pixels in the picture. FIG. 6 depict color samples thatcan be classified as ‘yellow’ color (plaque) or non-yellow color(normal).

Automated Selection

As it pertains to video recordings, each recording is broken down intoindividual frames. A random number generator is then used to randomlyselect a predetermined number of frames (e.g., 50) from one (1) to x,where x is the number of total images/frames within that recording. TheR code for this can be seen in FIG. 7. Generally, frames can be randomlyselected with or without specified criteria for the selection of frames.These criteria (e.g., a predetermined number of frames from eachquadrant, certain quality of the frame to minimize the noise, etc.) canbe inputted manually or can be learned automatically by the softwarealgorithm, for example via artificial intelligence. If any criteria arepresent, the imaging software can automatically select frames that arerelevant and/or discard frames that are not relevant. In any case, uponselection of the frames from the video recording, the correspondingimages from the individual frames are selected, and the yellowpercentage of the selected images are the calculated, as previouslydiscussed.

Any suitable methodology for randomly selecting frames/images from thevideo recording is contemplated herein. For illustration purposes,differing methodologies were tested herein for this random selection.First, the 50 images can be randomly selected, but only the portion ofthe image related to teeth for analysis, is selected and cropped, aspreviously discussed. Another methodology is selecting images from themiddle 60% of the complete video recording, thus truncating the first20% and the last 20% of the video recording. Yet another methodology issimply randomly selecting 50 images from the frames of the videorecording. Finally, each tooth can be selected, cropped, and analyzedseparately, and subsequently taking the average of the scores of theteeth.

TABLE 1 Dental plaque percentage comparison using different methods.Random Selection Random Individual Subject ID and with Selection RandomEvaluation Intervention selecting and with Selection Results Daycropping truncation Results (Benchmark) 1002-P3 0.0599 0.0981 0.09480.1571 1008-P5 0.0472 0.0465 0.1044 0.1163 1009-P5 0.0365 0.0500 0.04440.0481 1011-P5 0.4047 0.3899 0.3075 0.3611 1027-P3 0.0438 0.0220 0.04030.1127 1034-P3 0.1715 0.1364 0.1380 0.1757 1042-P5 0.3054 0.2293 0.22930.4311 1045-P3 0.0768 0.0861 0.09609 0.0424 1047-P3 0.0560 0.03750.08125 0.0531 1050-P3 0.1042 0.0500 0.03780 0.2149

Hardware and Software Infrastructure Examples

The present invention may be embodied on various computing platformsthat perform actions responsive to software-based instructions and mostparticularly on touchscreen portable devices. The following provides anantecedent basis for the information technology that may be utilized toenable the invention.

The computer readable medium described in the claims below may be acomputer readable signal medium or a computer readable storage medium. Acomputer readable storage medium may be, for example, but not limitedto, an electronic, magnetic, optical, electromagnetic, infrared, orsemiconductor system, apparatus, or device, or any suitable combinationof the foregoing. More specific examples (a non-exhaustive list) of thecomputer readable storage medium would include the following: anelectrical connection having one or more wires, a portable computerdiskette, a hard disk, a random access memory (RAM), a read-only memory(ROM), an erasable programmable read-only memory (EPROM or Flashmemory), an optical fiber, a portable compact disc read-only memory(CD-ROM), an optical storage device, a magnetic storage device, or anysuitable combination of the foregoing. In the context of this document,a computer readable storage medium may be any non-transitory, tangiblemedium that can contain, or store a program for use by or in connectionwith an instruction execution system, apparatus, or device.

A computer readable signal medium may include a propagated data signalwith computer readable program code embodied therein, for example, inbaseband or as part of a carrier wave. Such a propagated signal may takeany of a variety of forms, including, but not limited to,electro-magnetic, optical, or any suitable combination thereof. Acomputer readable signal medium may be any computer readable medium thatis not a computer readable storage medium and that can communicate,propagate, or transport a program for use by or in connection with aninstruction execution system, apparatus, or device.

Program code embodied on a computer readable medium may be transmittedusing any appropriate medium, including but not limited to wireless,wire-line, optical fiber cable, radio frequency, etc., or any suitablecombination of the foregoing. Computer program code for carrying outoperations for aspects of the present invention may be written in anycombination of one or more programming languages, including an objectoriented programming language such as Java, C#, C++, Visual Basic or thelike and conventional procedural programming languages, such as the “C”programming language or similar programming languages.

Aspects of the present invention are described below with reference toflowchart illustrations and/or block diagrams of methods, apparatus(systems) and computer program products according to embodiments of theinvention. It will be understood that each block of the flowchartillustrations and/or block diagrams, and combinations of blocks in theflowchart illustrations and/or block diagrams, can be implemented bycomputer program instructions. These computer program instructions maybe provided to a processor of a general purpose computer, specialpurpose computer, or other programmable data processing apparatus toproduce a machine, such that the instructions, which execute via theprocessor of the computer or other programmable data processingapparatus, create means for implementing the functions/acts specified inthe flowchart and/or block diagram block or blocks.

These computer program instructions may also be stored in a computerreadable medium that can direct a computer, other programmable dataprocessing apparatus, or other devices to function in a particularmanner, such that the instructions stored in the computer readablemedium produce an article of manufacture including instructions whichimplement the function/act specified in the flowchart and/or blockdiagram block or blocks.

The computer program instructions may also be loaded onto a computer,other programmable data processing apparatus, or other devices to causea series of operational steps to be performed on the computer, otherprogrammable apparatus or other devices to produce a computerimplemented process such that the instructions which execute on thecomputer or other programmable apparatus provide processes forimplementing the functions/acts specified in the flowchart and/or blockdiagram block or blocks.

It should be noted that when referenced, an “end-user” is an operator ofthe software as opposed to a developer or author who modifies theunderlying source code of the software. For security purposes,authentication means identifying the particular user while authorizationdefines what procedures and functions that user is permitted to execute.

GLOSSARY OF CLAIM TERMS

About: This term is used herein to refer to approximately or nearly andin the context of a numerical value or range set forth means±15% of thenumerical. In an embodiment, the term “about” can include traditionalrounding according to significant figures of the numerical value. Inaddition, the phrase “about ‘x’ to ‘y’” includes “about ‘x’ to about‘y’”.

Frame: This term is used herein to refer to a fraction/division of timeon a multimedia (e.g., video) timeline.

Oral health: This term is used herein to refer to the well-being ofone's mouth, specifically based herein on the plaque that may be presentin the person's mouth. More specifically, the manner in which plaqueaffects oral health can be the magnitude and ratio of dental plaque pertooth and across all teeth, the estimated age of dental plaque per toothand across all teeth, and the ratio of plaque burden to plaque age pertooth and across all teeth.

Random selection: This term is used herein to refer to a relativelyunpredictably chosen array of frames/images from a video recording. Theterm “relatively” is used because it is contemplated herein that thisrandom selection can be performed with or without a predetermined set ofcriteria for the selection. For example, if 1,000 frames are present ina video recording, a set of criteria may eliminate 200 of those frames,and then 50 frames can be “randomly selected” from the remaining 800frames. Alternatively, the 50 frames can be “randomly selected” from the1,000 frames with no criteria present. Both circumstances arecontemplated herein.

Single still frame digital image: This term is used herein to refer to avisual representation of a tooth extracted at a specific time during avideo recording.

Substantially all: This term is used herein to refer to a representativenumber of tooth surfaces that, when analyzed, can be used tocharacterize the amount of plaque across all teeth or on each tooth.This number can be all teeth in the subject's mouth, or it can be anamount less than all of the teeth. For example, some teeth may beinaccessible by an intraoral camera due to the anatomy of a particularsubject's mouth, so only the accessible surfaces are recorded. Thesecircumstances are still considered herein as “substantially all”.

The advantages set forth above, and those made apparent from theforegoing description, are efficiently attained. Since certain changesmay be made in the above construction without departing from the scopeof the invention, it is intended that all matters contained in theforegoing description or shown in the accompanying drawings shall beinterpreted as illustrative and not in a limiting sense.

It is also to be understood that the following claims are intended tocover all of the generic and specific features of the invention hereindescribed, and all statements of the scope of the invention that, as amatter of language, might be said to fall there between.

What is claimed is:
 1. A method of assessing oral health in a patient orsubject, comprising the steps of: providing an intraoral camera that cancapture or record frames within a mouth of said subject; using theintraoral camera, capturing or recording the frames of substantially allbuccal, occlusal, and lingual surfaces in the subject's set of teeth;importing the frames into an image processing software programimplemented on a computing device; processing the frames on the imageprocessing software program to generate images of the teeth to beanalyzed; analyzing and classifying color of at least a plurality of theframes to determine presence of yellow color, wherein the yellow colorindicates presence of plaque; scoring results of the color analysis toobjectively and quantitatively assess the oral health of the subject. 2.A method as in claim 1, further comprising the steps of positioning adental barrier over a lens of the intraoral camera and positioning acamera tip of the intraoral camera over the dental barrier.
 3. A methodas in claim 1, wherein the captured frames are photographs taken by theintraoral camera.
 4. A method as in claim 3, further comprising the stepof dividing the subject's set of teeth into a plurality of sections,wherein the sections include an upper right section, a lower rightsection, an upper middle section, a lower middle section, an upper leftsection, and a lower left section.
 5. A method as in claim 3, whereinthe step of processing the frames is performed by cropping each imagesuch that the image includes a targeted tooth in the image.
 6. A methodas in claim 5, wherein the step of processing the frames is furtherperformed by lowering a resolution of the image to a percentage of about50 or less.
 7. A method as in claim 5, wherein the step of analyzing andclassifying the color is performed by classifying the color of eachpixel of the image.
 8. A method as in claim 7, wherein the color of theeach pixel is classified using red-green-blue color code combinations,wherein a three-dimensional point (x, y, z) defines the color of theeach pixel.
 9. A method as in claim 8, wherein the step of analyzing andclassifying the color is further performed by: dividing each colordimension of the red-green-blue color code combinations into fourcategories, wherein the four categories are (0, 64), (64, 128), (128,192), and (192, 255); selecting a middle point in each category to berepresentative of the corresponding category; and scoring all categoriesto determine when the yellow color is present on the each pixel.
 10. Amethod as in claim 9, wherein the yellow color is present on the eachpixel when a value of a red dimension is between about 0.75 times of avalue of a green dimension and about 2.5 times of the value of the greendimension, and when the values of the green and red dimensions are atleast about 1.2 times a value of a blue dimension.
 11. A method as inclaim 7, wherein the step of scoring the results of the color analysisincludes calculating a percentage of the yellow color by dividing anumber of yellow pixels by a total number of pixels in the image.
 12. Amethod as in claim 1, wherein the captured frames are video recordings.13. A method as in claim 12, further comprising the step of dividing thesubject's set of teeth into a plurality of quadrants, wherein thequadrants include an upper right quadrant, a lower right quadrant, anupper left quadrant, and a lower left quadrant.
 14. A method as in claim13, wherein the step of capturing or recording the frames includescapturing and recording video of the tooth surfaces in at least oneupper quadrant and in at least one lower quadrant.
 15. A method as inclaim 13, wherein the step of capturing or recording the frames includescapturing and recording video of the buccal surfaces in a quadrant,followed by capturing and recording video of the occlusal surfaces inthe quadrant, followed by capturing and recording video of the lingualsurfaces in the quadrant, and followed by repeating the foregoing stepsin another quadrant.
 16. A method as in claim 12, wherein the step ofprocessing the frames on the image processing software program includesextracting single still frame digital images of the tooth surfaces fromthe video recording.
 17. A method as in claim 16, wherein the step ofprocessing the frames is performed by cropping each image such that theimage includes a targeted tooth in the image.
 18. A method as in claim17, wherein the step of processing the frames is further performed bylowering a resolution of the image to a percentage of about 50 or less.19. A method as in claim 17, wherein the step of analyzing andclassifying the color is performed by classifying the color of eachpixel of the image.
 20. A method as in claim 19, wherein the color ofthe each pixel is classified using red-green-blue color codecombinations, wherein a three-dimensional point (x, y, z) defines thecolor of the each pixel.
 21. A method as in claim 20, wherein the stepof analyzing and classifying the color is further performed by: dividingeach color dimension of the red-green-blue color code combinations intofour categories, wherein the four categories are (0, 64), (64, 128),(128, 192), and (192, 255); selecting a middle point in each category tobe representative of the corresponding category; and scoring allcategories to determine when the yellow color is present on the eachpixel.
 22. A method as in claim 21, wherein the yellow color is presenton the each pixel when a value of a red dimension is between about 0.75times of a value of a green dimension and about 2.5 times of the valueof the green dimension, and when the values of the green and reddimensions are at least about 1.2 times a value of a blue dimension. 23.A method as in claim 19, wherein the step of scoring the results of thecolor analysis includes calculating a percentage of the yellow color bydividing a number of yellow pixels by a total number of pixels in theimage.
 24. A method as in claim 16, further comprising the step ofrandomly selecting a plurality of frames from all of the captured framesprior to processing the frames on the image processing software program,wherein the random selection of the plurality of frames is performedwith or without criteria for the random selection.
 25. A method ofassessing oral health in a patient or subject, comprising the steps of:providing an intraoral camera that can capture or record frames within amouth of said subject; positioning a dental barrier over a lens of theintraoral camera and positioning a camera tip of the intraoral cameraover the dental barrier; dividing the subject's set of teeth into aplurality of quadrants, wherein the quadrants include an upper rightquadrant, a lower right quadrant, an upper left quadrant, and a lowerleft quadrant; using the intraoral camera, capturing or recording theframes of substantially all buccal, occlusal, and lingual surfaces inthe subject's set of teeth, wherein the captured frames are videorecordings, wherein the step of capturing or recording the framesincludes capturing and recording video of the tooth surfaces in at leastone upper quadrant and in at least one lower quadrant, wherein the stepof capturing or recording the frames includes capturing and recordingvideo of the buccal surfaces in a quadrant, followed by capturing andrecording video of the occlusal surfaces in the quadrant, followed bycapturing and recording video of the lingual surfaces in the quadrant,and followed by repeating the foregoing steps in another quadrant;importing the frames into an image processing software programimplemented on a computing device; randomly selecting a plurality offrames from all of the captured frames, wherein the random selection ofthe plurality of frames is performed with or without criteria for therandom selection; processing the frames on the image processing softwareprogram to generate images of the teeth to be analyzed, wherein the stepof processing the frames on the image processing software programincludes extracting single still-framed digital images of the toothsurfaces from the video recording, wherein the step of processing theframes is performed by cropping each image such that the image includesa targeted tooth in the image and lowering a resolution of the image toa percentage of about 50 or less; analyzing and classifying color of atleast a plurality of the frames to determine presence of yellow color,wherein the yellow color indicates presence of plaque, wherein the stepof analyzing and classifying the color is performed by classifying thecolor of each pixel of the image, wherein the color of the each pixel isclassified using red-green-blue color code combinations, wherein athree-dimensional point (x, y, z) defines the color of the each pixel,wherein the step of analyzing and classifying the color is furtherperformed by: dividing each color dimension of the red-green-blue colorcode combinations into four categories, wherein the four categories are(0, 64), (64, 128), (128, 192), and (192, 255), selecting a middle pointin each category to be representative of the corresponding category, andscoring all categories to determine when the yellow color is present onthe each pixel, wherein the yellow color is present on the each pixelwhen a value of a red dimension is between about 0.75 times of a valueof a green dimension and about 2.5 times of the value of the greendimension, and when the values of the green and red dimensions are atleast about 1.2 times a value of a blue dimension; scoring results ofthe color analysis to objectively and quantitatively assess the oralhealth of the subject, wherein the step of scoring the results of thecolor analysis includes calculating a percentage of the yellow color bydividing a number of yellow pixels by a total number of pixels in theimage.